Exile on Jones Street: Death panels of the Old North State

by Kirk Ross

Where are you o prophets of doom? Whither thee, oracles of Obamacare? For we in North Carolina are afflicted as you predicted.

The death panels have arrived, but not exactly in the form you described. Those fearsome panels have delivered their fatal decisions not in some windowless star chamber, but in corporate boardrooms and offices of our own state government.

Clever, these death panels.

Predicting that people would die as a result of the largest change in healthcare policy in the largest economy in the world did not take clairvoyance. A clear-headed reading of the various mechanisms of the Affordable Care Act foretold more than a few pitfalls.

Top of the list of danger signs was what was going to happen to rural healthcare if states did not opt for expansion of Medicaid. Among the notable changes was in the way smaller, mostly rural hospitals were to be compensated. As ACA phased in, support for these hospitals stepped down.

During the debate over ACA in this state, expansion proponents often cited the impact on the hospitals and on rural health in general as key reasons to expand. Everyone knew this going in.

Now, it’s happening.

You may have seen in the news that the mayor of the small coastal community of Bellhaven is walking to Washington, DC to try and get the hospital in his town reopened. Pungo District Hospital, which served Beaufort and Hyde counties, closed July 1 after the corporation that owns it backed out of a complicated agreement to keep it open. The move will shore up the bottom line of the company’s other hospitals, but closing of Pungo puts tens of thousands of citizens more than an hour away from the nearest emergency room.

Bellhaven Mayor Adam O’Neil, a Republican, has been in a long fight to stop the closing. After the hospital finally shut down and a local woman died waiting for an airlift to the nearest medical center, it all got a lot more personal.

O’Neil and a group of supporters walked about 14 miles the first day and plan to up the pace and finish in about 17 days.

Not every small-town mayor is going to channel his fury at being caught in the political crossfire by walking to Washington, but nearly every one of them is going to be challenged by what’s happening. As O’Neil noted in a letter announcing his walk, last year more rural hospitals closed than in all 15 years prior.

This wave of closures is going to hit us hard in North Carolina where the growth may be in cities, but our rural population still sits at close to 3 million people.[pullquote]O’Neil and a group of supporters walked about 14 miles the first day and plan to up the pace and finish in about 17 days.[/pullquote]

Our rural citizens are generally older. They also tend to have greater healthcare needs and higher poverty rates than the overall population. Limited access to services and long distances to providers make it harder for them to get the care they’ll need.

Improving rural health, especially maternal and child health in the face of stunning infant mortality rates, used to be a mission for the state. For decades, nearly every session of the General Assembly resulted in some new advancement or improvement in rural healthcare.

Now, after the stubborn refusal to even consider expansion, we’re about to see a rollback of rural healthcare at a rate that’s hard to imagine. Before long, what happened in Bellhaven won’t be all that rare.

Without the additional dollars Medicaid expansion would provide, more closings are on the horizon as corporations, not-for-profit and otherwise, start consolidating operations.

The effect of all this is devastating to local communities and their economies. The greatest harm of these actions is to the most vulnerable: the elderly, sick and newborns. There’ll be fewer people getting preventive care, fewer mothers getting prenatal care, sicker people ending up in hospital emergency rooms a county away.

You can call that anything you want, but it looks an awful lot like a corporate death panel.